Background: Immunizations are one of the greatest public health accomplishments of both the 19th and 20th centuries (Zhou et al., 2014). The Centers for Disease and Control Prevention (CDC) (2014) predicts 322 million illnesses, 21 million hospitalizations, and 732,000 deaths will be prevented by immunizations during the lifespan of children born during 1994-2014. In addition, the United Nations Sustainable Development Goals call for good health and well-being through the research, development, and use of vaccines. Despite the importance of immunization in the prevention of disease, lack of formal education on vaccines and streams of conflicting messages on social media overshadow credible information and result in parents choosing to not vaccinate their children (Hoekstra & Margolis, 2016). Furthermore, the enormous amount of complex information available surrounding vaccines can lead to poor understanding of vaccines by the public in general (Wade, 2014). Currently, vaccine coverage for adults remains low (Williams et al., 2017) and recent estimates of overall vaccine coverage (combined 7-vaccine series) for children can be as low as 72.2% (National Center for Health Statistics, 2017).
Considering the possibility of poor understanding of vaccines by the public and the need for continued improvement in immunization rates, it is essential that healthcare providers become more educated and more adept at working to improve immunization rates. In particular, nurses are important contributors to the effort of advancing immunization rates. As the most trusted profession in the United States (Brenan, 2017), nurses are in a unique position to be influential in the decision of patients to be immunized. Patients trust nurses to give them the best counsel on how to protect their health and nurses’ recommendations increase vaccination rates (Bakhshi & While, 2014). Surprisingly, gaps in vaccine knowledge exist in newly graduated health care professionals. Knowledge gaps create barriers for nurses to promote immunization (Fagundes, Frota, & Silva, 2018). Therefore, teaching vaccine science and techniques to endorse immunization in nursing school curriculum is critical. One effort to prepare student nurses to act as vaccine advocates is to require the completion of three online, self-study, modules. These innovative and creative web-based modules sponsored by the Nursing Initiative Promoting Immunization Training (NIP-IT) teach the science of vaccines and are intended to inform and educate nursing students and nurses nationwide. Access to these modules online and without charge is made possible by a cooperative agreement between the University of Oklahoma College of Nursing and the Centers for Disease Control and Prevention.
Methods: Nursing students enrolled in a Community Health Nursing course were required to complete three online, self-study, modules entitled Vaccine Preventable Diseases, Vaccine Concerns, and Nursing Roles. Students who completed these modules responded, in writing, to an open-ended prompt asking them to identify what new piece of information they learned. Responses gathered from 243 nursing students between September of 2016 and April of 2018 were categorized and grouped according to theme using a first and second cycle coding process. Some responses contained more than one idea. Each idea was considered as a separate response and categorized accordingly.
Results: Nursing student responses revealed six major themes regarding new information learned from the modules. From most to least frequently mentioned the following themes were discovered: (1) awareness and prevalence of vaccine concerns, (2) characteristics of vaccines such as additives, preservatives, and types, (3) the impact of nurses on vaccination, (4) greater understanding of vaccine-preventable diseases (VPDs), signs, symptoms, and sequelae, (5) function and importance of community immunity, and (6) miscellaneous.
Conclusion: This exercise illuminated fundamental vaccine knowledge deficits in student nurses. Considering these knowledge gaps, formal vaccine education is an essential component of a comprehensive nursing program. Education should include evidenced-based information to address common vaccine concerns, signs and symptoms of VPDs and the types of vaccines used to prevent VPDs, and the role of nurses in promoting vaccination for the increased immunity of individuals and communities.
Nursing implications: In order to address vaccine and immunization knowledge gaps, thorough and formal vaccine education in nursing programs is critical in developing health care professionals capable of promoting health and preventing disease through vaccination advocacy.